Medicare Part B (Medical Insurance) will cover a hospital bed as durable medical equipment (DME) that your doctor prescribes for use in your home. If you have Medicare Part B (as a part of Original Medicare), or you have this benefit as a part of a Medicare Advantage plan, then you are eligible for this coverage.
Provided that your supplier accepts Medicare assignment, then you will be required to pay 20 percent of the Medicare-approved amount. In addition, the Medicare Part B annual deductible will also apply. For 2015, the amount of this deductible is $147.
It is important to note that Medicare will pay for different types of durable medical equipment (DME) in different ways. For example, depending on the type of equipment, you may need to rent it, or you may need to buy it. Or, you may be able to choose whether you rent or purchase the equipment.
Medicare will only cover the durable medical equipment provided that your doctor(s) and your medical equipment supplier(s) are enrolled in Medicare. Doctors and medical equipment suppliers must meet strict standards in order to enroll – and to remain enrolled – in Medicare. If your doctors and / or suppliers are not enrolled, then Medicare will not pay the claims that are submitted by them.
It is important that you inquire from your medical equipment suppliers as to whether or not they participate in Medicare before you obtain any durable medical equipment from them. If they are participating suppliers, they must accept Medicare assignment. If suppliers are enrolled in Medicare, but they are not “participating,” then they may choose not to accept assignment. If a supplier does not accept assignment, there is no limit on the amount that they can charge you.
The Competitive Bidding Program
If you live in or visit certain areas, then you may be affected by Medicare’s Competitive Bidding Program. Medicare is phasing in this program in some areas of the country. This program changes the amount that Medicare pays suppliers for certain durable medical equipment (DME), and it also changes who may supply these items.
Under this program, suppliers submit bids in order to set the amount that they pay for the equipment and supplies. The qualified, accredited suppliers that have winning bids are then chosen as Medicare contract suppliers.
The Competitive Bidding Program is meant to help Medicare enrollees and Medicare save money. It also is intended to provide Medicare enrollees access to quality medical equipment, supplies, and services from trustworthy suppliers. In addition, the program may also help in limiting fraud and abuse within the Medicare program.
If you are enrolled in Medicare Part A and Part B (Original Medicare) and you get competitively bid equipment and supplies in competitive bidding areas, then Medicare may only help to pay for these equipment and supplies if they are provided by contract suppliers.
A contract supplier is not allowed to charge you more than the 20 percent co-insurance amount and any unmet annual deductible for any equipment or supplies included in the Competitive Bidding Program.
In order to determine how much a specific item will cost, talk to your doctor or other health care provider. This is because the specific amount that you owe can depend on a variety of different factors, such as other insurance that you may have, how much the supplier charges, and / or where you obtain your item.